Posts filed under ‘Desinfection and Sterilization’

Editorial – Vancomycin Prophylaxis for Total Joint Arthroplasty: Incorrectly Dosed and Has a Higher Rate of Periprosthetic Infection Than Cefazolin

Clinical Orthopaedics and Related Research July 2017 V.475 N.7 P.1762-1766

 

Daniel Wongworawat MD

PDF

https://link.springer.com/content/pdf/10.1007%2Fs11999-017-5354-1.pdf

July 30, 2017 at 3:00 pm

Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention.

MMWR Recomm Rep. 2002 Aug 9;51(RR-10):1-29.

O’Grady NP1, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA.

Author information

1 National Institutes of Health, Bethesda, Maryland, USA.

Abstract

These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings.

This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery anesthesiology interventional radiology pulmonary medicine, pediatric medicine, and nursing.

The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology ofAmerica (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device-Related Infections published in 1996 These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections.

Major areas of emphasis include

1) educating and training health-care providers who insert and maintain catheters;

2) using maximal sterile barrier precautions during central venous catheter insertion;

3) using a 2% chlorhexidine preparation for skin antisepsis;

4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and

5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis).

These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.

PDF

https://www.cdc.gov/mmwr/PDF/rr/rr5110.pdf

ERRATUM

https://www.cdc.gov/mmwr/PDF/wk/mm5132.pdf

July 26, 2017 at 4:47 pm

Rapid and Accurate Molecular Identification of the Emerging Multidrug-Resistant Pathogen Candida auris

Journal of Clinical Microbiology August 2017 V.55 N.8 P.2445-2452

Milena Kordalewska, Yanan Zhao, Shawn R. Lockhart, Anuradha Chowdhary, Indira Berrio, and David S. Perlin

aPublic Health Research Institute, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA

bMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

cDepartment of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India

dClínica El Rosario, Medellín, Colombia

eMedical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia

fHospital General de Medellin Luz Castro de Gutiérrez ESE, Medellín, Colombia

Candida auris is an emerging multidrug-resistant fungal pathogen causing nosocomial and invasive infections associated with high mortality. C. auris is commonly misidentified as several different yeast species by commercially available phenotypic identification platforms. Thus, there is an urgent need for a reliable diagnostic method. In this paper, we present fast, robust, easy-to-perform and interpret PCR and real-time PCR assays to identify C. auris and related species: Candida duobushaemulonii, Candida haemulonii, and Candida lusitaniae. Targeting rDNA region nucleotide sequences, primers specific for C. auris only or C. auris and related species were designed. A panel of 140 clinical fungal isolates was used in both PCR and real-time PCR assays followed by electrophoresis or melting temperature analysis, respectively. The identification results from the assays were 100% concordant with DNA sequencing results. These molecular assays overcome the deficiencies of existing phenotypic tests to identify C. auris and related species.

PDF

http://jcm.asm.org/content/55/8/2445.full.pdf+html

July 26, 2017 at 9:29 am

Surveillance and outbreak report LEGIONNAIRES’ DISEASE IN EUROPE, 2011 TO 2015

Eurosurveillance July 06, 2017 V.22 N.27

J Beauté 1 2 , on behalf of the European Legionnaires’ Disease Surveillance Network 3

  1. European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
  2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  3. The members of the network are listed at the end of the article

Under the coordination of the European Centre for Disease Prevention and Control (ECDC), the European Legionnaires’ disease Surveillance Network (ELDSNet) conducts surveillance of Legionnaires’ disease (LD) in Europe. Between 2011 and 2015, 29 countries reported 30,532 LD cases to ECDC (28,188 (92.3%) confirmed and 2,344 (7.7%) probable). Four countries (France, Germany, Italy and Spain) accounted for 70.3% of all reported cases, although their combined populations represented only 49.9% of the study population. The age-standardised rate of all cases increased from 0.97 cases/100,000 population in 2011 to 1.30 cases/100,000 population in 2015, corresponding to an annual average increase of 0.09 cases/100,000 population (95%CI 0.02–0.14; p = 0.02). Demographics and infection setting remained unchanged with ca 70% of cases being community-acquired and 80% occurring in people aged 50 years and older. Clinical outcome was known for 23,164 cases, of whom 2,161 (9.3%) died. The overall case fatality ratio decreased steadily from 10.5% in 2011 to 8.1% in 2015, probably reflecting improved reporting completeness. Five countries (Austria, Czech Republic, Germany, Italy, and Norway) had increasing age-standardised LD notification rates over the 2011−15 period, but there was no increase in notification rates in countries where the 2011 rate was below 0.5/100,000 population….

FULL TEXT

http://eurosurveillance.org/ViewArticle.aspx?ArticleId=22829

PDF

http://eurosurveillance.org/images/dynamic/EE/V22N27/art22829.pdf

July 12, 2017 at 8:20 am

Recomendaciones para la prevención de infecciones asociadas a artoplastia electiva en adultos

Medicina (B. Aires) Abril 2017 V.77 N.2

Juan Carlos Chuluyán1*, Andrea Vila2*, Ana Laura Chattás3*, Marcelo Montero3*, Claudia Pensotti4*+, Claudia Tosello5*, Marisa Sánchez6*, Cecilia Vera Ocampo7*, Guillermina Kremer8*, Rodolfo Quirós8*, Guillermo A. Benchetrit9*, Carolina Fernanda Pérez10*, Ana Laura Terusi11*, Francisco Nacinovich12*

1Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. Álvarez,

2Servicio de Infectología, Hospital Italiano de Mendoza,

3Hospital General de Agudos Dr. Pirovano,

4Clínica Monte Grande,

5Hospital de Clínicas José de San Martín, UBA,

6Hospital Italiano de Buenos Aires,

7Sanatorio Dupuytren,

8Hospital Universitario Austral,

9Instituto de Investigaciones Médicas A. Lanari, UBA,

10Policlínico del Docente-Centro Médico Huésped,

11Instituto César Milstein,

12Instituto Cardiovascular de Buenos Aires, Centros Médicos Dr. Stamboulian, Argentina

*En representación del grupo de trabajo en infecciones osteoarticulares de la Sociedad Argentina de Infectología

+In memoriam

Dirección postal: Juan Carlos Chuluyan, Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. Álvarez, J. F. Aranguren 2701, 1406 Buenos Aires, Argentina

e-mail: jcchulu@gmail.com

Resumen

Las infecciones del sitio quirúrgico que complican las cirugías ortopédicas con implante prolongan la estadía hospitalaria y aumentan tanto el riesgo de readmisión como el costo de la internación y la mortalidad.

Las presentes recomendaciones están dirigidas a:

(i) optimizar el cumplimiento de normas y la incorporación de hábitos en cada una de las fases de la cirugía, detectando factores de riesgo para infecciones del sitio quirúrgico potencialmente corregibles o modificables; y

(ii) adecuar la profilaxis antibiótica preoperatoria y el cuidado intra y postoperatorio.

FULL TEXT

http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0025-76802017000200014

 

– – –

July 9, 2017 at 3:50 pm

Staphylococcus lugdunensis, a serious pathogen in periprosthetic joint infections: comparison to Staphylococcus aureus and Staphylococcus epidermidis.

Int J Infect Dis. Oct. 2016 V.51 P56-61.

Lourtet-Hascoët J1, Bicart-See A2, Félicé MP3, Giordano G4, Bonnet E2.

Author information

1 Microbiological Laboratory, Hôpital J. Ducuing, 15 rue Varsovie, 31300 Toulouse, France. Electronic address: julielourtet@hotmail.com

2 Infectious Diseases Mobile Unit, J. Ducuing Hospital, Toulouse, France.

3 Microbiological Laboratory, Hôpital J. Ducuing, 15 rue Varsovie, 31300 Toulouse, France.

4 Traumatology and Orthopaedic Surgery Department, J. Ducuing Hospital, Toulouse, France.

Abstract

OBJECTIVES:

The aim of this study was to assess the characteristics of periprosthetic joint infection (PJI) due to Staphylococcus lugdunensis and to compare these to the characteristics of PJI due to Staphylococcus aureus and Staphylococcus epidermidis.

METHODS:

A retrospective multicentre study including all consecutive cases of S. lugdunensis PJI (2000-2014) was performed. Eighty-eight cases of staphylococcal PJI were recorded: 28 due to S. lugdunensis, 30 to S. aureus, and 30 to S. epidermidis, as identified by Vitek 2 or API Staph (bioMérieux).

RESULTS:

Clinical symptoms were more often reported in the S. lugdunensis group, and the median delay between surgery and infection was shorter for the S. lugdunensis group than for the S. aureus and S. epidermidis groups. Regarding antibiotic susceptibility, the S. lugdunensis strains were susceptible to antibiotics and 61% of the patients could be treated with levofloxacin + rifampicin. The outcome of the PJI was favourable for 89% of patients with S. lugdunensis, 83% with S. aureus, and 97% with S. epidermidis.

CONCLUSION:

S. lugdunensis is an emerging pathogen with a pathogenicity quite similar to that of S. aureus. This coagulase-negative Staphylococcus must be identified precisely in PJI, in order to select the appropriate surgical treatment and antibiotics .

PDF

http://www.ijidonline.com/article/S1201-9712(16)31132-8/pdf

June 20, 2017 at 7:44 pm

Clindamycin-rifampin combination therapy for staphylococcal periprosthetic joint infections: a retrospective observational study.

BMC Infect Dis. May 2, 2017 V.17 N.1 P.321.

Leijtens B1, Elbers JBW2, Sturm PD3, Kullberg BJ4, Schreurs BW2.

Author information

1 Department of Orthopaedic Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. borg.leijtens@radboudumc.nl.

2 Department of Orthopaedic Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.

3 Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.

4 Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands.

Abstract

BACKGROUND:

Staphylococcal species account for more than 50% of periprosthetic joint infections (PJI) and antimicrobial therapy with rifampin-based combination regimens has been shown effective. The present study evaluates the safety and efficacy of clindamycin in combination with rifampin for the management of staphylococcal PJI.

METHODS:

In this retrospective cohort study, patients were included who received clindamycin-rifampin combination therapy to treat a periprosthetic hip or knee infection by Staphylococcus aureus or coagulase-negative staphylococci. Patients were treated according to a standardized treatment algorithm and followed for a median of 54 months. Of the 36 patients with periprosthetic staphylococcal infections, 31 had an infection of the hip, and five had an infection of the knee. Eighteen patients underwent debridement and retention of the implant (DAIR) for an early infection, the other 18 patients underwent revision of loose components in presumed aseptic loosening with unexpected positive cultures.

RESULTS:

In this study, we report a success rate of 86%, with five recurrent/persistent PJI in 36 treated patients. Cure rate was 78% (14/18) in the DAIR patients and 94% (17/18) in the revision group. Five patients (14%) discontinued clindamycin-rifampin due to side effects. Of the 31 patients completing the clindamycin-rifampin regimen 29 patients (94%) were cured.

CONCLUSION:

Combined therapy with clindamycin and rifampin is a safe, well tolerated and effective regimen for the treatment of staphylococcal periprosthetic infection.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414295/pdf/12879_2017_Article_2429.pdf

June 20, 2017 at 7:11 pm

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